Utilization Management Specialist III – IDD

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Conduct clinical assessments of service authorization requests to determine the necessary level of care.

• Assess authorization requests for medical necessity and the suitable level of care.

• Approve, modify, or suggest denial of services based on clinical guidelines and established criteria.

• Analyze clinical documentation, diagnoses, and treatment plans.

• Offer clinical consultation to providers and internal teams concerning service requests.

• Execute clinical triage and assist in referral decisions based on member requirements.

• Engage in appeals, mediations, administrative hearings, and post-service clinical evaluations.

⛳️ Requirements

• Master’s degree in health and human services or a related discipline.

• A minimum of one (1) year of experience in providing Utilization Management services.

• Current North Carolina licensure as a Licensed Clinical Social Worker (LCSW), Licensed Clinical Mental Health Counselor (LCMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Psychological Associate (LPA), Licensed Clinical Addictions Specialist (LCAS), or Registered Nurse (RN).

• Valid driver's license is required.

• Candidate must reside within North Carolina.

• Ability to travel within the catchment area as necessary.

• Preferred: At least two (2) years of post-Master's experience in a clinical environment with the IDD/BH/MH/SU population.

• Successful completion of a drug test is a condition of employment.

• Resume should include employer names, service dates, average weekly hours worked, key job responsibilities, educational background, and licensure/certification details.

🏝️ Benefits

• Collaborative, mission-oriented work environment.

• Competitive benefits offered.

• Work-from-home options available for most positions.

• Opportunities for professional development.

• Flexible work schedules may be available for certain positions with management approval.

• Health insurance with no premium for employee coverage.

• Flexible Spending Accounts available.

• 24 days of Paid Time Off (PTO) plus 12 paid holidays during your first year.

• NC Local Government Retirement Pension (defined-benefit plan).

• 401k with a 5% employer match and immediate vesting.

• Qualifying employer for Public Service Loan Forgiveness (PSLF).

• Quarterly stipend for remote work supplies.